information about you and your child

Child's name :*

Child's date of birth (DAY/MONTH/YEAR):*

Child's age (at date of club):*

child's gender:

Any allergies or special dietary requirements?:

If YES, please tell us about it here (including any medications)::

Any medical or behavioural conditions, or special learning needs?:

If YES please tell us about it here (including any medications):

Doctor's Surgery:*

Surgery telephone number:*

Can your child swim at least one length of a standard pool unaided?:

CLUB(S) booked - please list dates and age group/club name:*

PAYMENT METHOD::

ONLINE using BACS: Please send me the bank account details
CASH IN PERSON (please see Margaret at The Bursary, Sherborne Prep School, 39 Acreman St, Sherborne DT9 3NY)
CHEQUE (payable to Sherborne Preparatory School)
CHILDCARE VOUCHERS (please specify below)

Childcare Voucher details::

parent/guardian name(s):*

home address:*

postcode:*

daytime phone number:*

Mobile Number:*

email address:*

I agree to my child being included in any photos/recordings/filming: